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Stage II Palliation for Hypoplastic Left Heart Syndrome without Cardiopulmonary Bypass *Anthony Azakie, MD1, Natalie C Johnson, BS1, Petros V Anagnostopoulos, MD1, Mohammed S Akram, MD3, Patrick McQuillen, MD2, Anil Sapru, MD21Department of Surgery, University of California, San Francisco, 2Department of Pediatrics, University of California, San Francisco, 3Department of Surgery, Drexel University OBJECTIVES: The bidirectional cavopulmonary anastomosis (BCPA) has been performed without cardiopulmonary bypass (CPB) for some single ventricle heart defects. Limited data is available for the outcomes of off-pump BCPA in infants with hypoplastic left heart syndrome (HLHS). The purpose of this study is to determine the early outcomes for stage II palliation for HLHS without CPB. METHODS: Retrospective review of infants having surgical palliation for HLHS from 4/2003 to 3/2010 at a single institution. RESULTS: 75 infants had a modified Norwood procedure, 65 with right ventricle to pulmonary artery conduit, 10 with aortopulmonary shunt, 2 with atrioventricular valve repair, and 3 with extracorporeal life support. 68 had HLHS or one of its variants and 7 had other single ventricle lesions. There were 2 stage I deaths. Stage I survival was 97% (95%CI 88-99%). Another 5 infants succumbed in the interstage period. Of the 68 stage I and interstage survivors, 60 had BCPA, 19 without CPB. Median age was 6 months (range 4-13 months) and median weight was 6.1kg (range 5.2-9.0kg). There were no conversions to CPB when off-pump BCPA was attempted. There were no hospital deaths. Median ventilation duration was 10 hours (range 6-18 hours) and length of stay was 6 days (range 4-9 days). Follow-up was available on all infants at a median duration of 17 months (range 2-43 months) with no unplanned reinterventions. CONCLUSIONS: BCPA without the use of CPB can be performed safely and with low mortality for selected infants with HLHS. Mid- to long-term outcomes remain to be determined. Back to Scientific Program Back to 2010 Annual Meeting
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